Bronchial atresia is a rare condition that is caused by the congenital occlusion of a proximal bronchus, which is likely the consequence of a vascular insult that occurs early in gestation. Because the involved bronchus does not communicate with the central airway, the distal bronchi become impacted with mucus and aeration occurs via collateral channels; this leads to the characteristic bronchocele formation with surrounding hyperinflation. The true incidence of this anomaly is uncertain. Most patients present with an incidental solitary pulmonary nodule; some patients may experience cough, dyspnea, recurrent infection, wheezing, and, rarely, hemoptysis. The diagnosis of bronchial atresia is suggested by the presence of a perihilar density associated with regional hyperinflation on chest radiograph. CT scan is the modality of choice for confirmation of the diagnosis, because it can differentiate the bronchocele from other entities that cause mucoid impaction, and airtrapping can be demonstrated on expiratory imaging. Furthermore, multidetector CT techniques can delineate the 3-dimensional anatomy of the atretic bronchus. Differential diagnostic considerations encompass a variety of neoplastic, inflammatory, congenital, and vascular disorders. In the past, the management of bronchial atresia consisted of surgical excision for both diagnosis and treatment. Modern imaging techniques have allowed the diagnosis of bronchial atresia to be made radiographically. Therefore, the role of surgery is now limited to the treatment of symptomatic individuals.
*Departments of Pulmonary and Critical Care Medicine and †Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH; ‡Department of Radiology, Duke University Medical Center, Duke University, Durham, NC.
Address correspondence to: Paul A. Lange, M.D., Assistant Professor, Division of Pulmonary and Critical Care Medicine, Case Western Reserve University, University Hospitals of Cleveland, 11100 Euclid Ave, Cleveland, OH 44106.